I wrote JAYA AND RASA: A LOVE STORY as if both Jaya and Rasa were my patients (they are amalgams of a number of real teen patients).

1st part of book: how their past negative experiences contributed to how they learned to think, feel, and act in order to survive.

2nd part of book: they meet and their relationship blooms into the first positive intimate relationship for them both.

Ending: the book ends with a mutual corrective emotional experience (a CEE is one way a traumatized person can learn both intellectually and emotionally how positive relationships work and therefore begin to contemplate how to live “happily ever after”).

Keep it real or you might die. Sound extreme? Let me explain this short but profound sentence I often use to help struggling teens in my child and adolescent psychiatry practice. I’ll start by breaking it down into two parts.

Keep it real = Determine your true thoughts and feelings in the moment and speak up for yourself in all honesty.Or you might die = If you stay quiet and believe the negative automatic thoughts, feelings, and risky impulses that your mind is tricking you with then you might be more likely to go through with the risky impulses (suicide attempts, accidental excessive drug/alcohol use, unprotected sex, etc.) because there doesn’t seem to be any other way out of the intolerable swirl of chaos in your mind.

Obvious? Not to everyone, especially not to vulnerable teens. These are the pained teens—from all walks of life—I have the honor of treating. These are the teens who have a genetic predisposition to an emotional illness (such as depression or anxiety), have lived through trauma, or have dysfunctional family systems—or all three. These teens are more likely to remain silent about the unwanted, false, automatic negative thoughts, feelings, and impulses that plague them. For different reasons, these teens aren’t taught to speak up about, tolerate, or cope with all the negativity. This silent suffering becomes their invisible “teacher” and they learn to act out on their self-destructive impulses. Soon the only way they know how to minimize emotional distress is to act out with dangerous behaviors. It may become hardwired into their brains.

I value meaningful talk therapy as the foundation of my psychiatric treatment to teens. It is my goal to educate them on positive ways to maneuver through life. Over the course of weeks, months, or years we work together to discover how they can become self-aware, how they can say exactly what’s on their mind in any given situation, and how they can ride out the extremes of their negative thoughts, feelings, and impulses.

How they can keep it real so they don’t die.

I strive to be their keep it real coach. There is no better reward than to watch these teens learn to find their voices and be assertive. They become keep it real experts.

I also aim to be a keep it real author. I want to bring this powerful message to as many teens as I can. That is why I write YA novels the way I do—boiled down and raw.

In my office, teens who confide in me don’t speak in perfect prose when they share their innermost thoughts, feelings, impulses, and secrets. They might stumble on their words. They might not be able to find the right words. They might get straight to the point. They might ramble. They might swear. They might cry. They might scream. They might do a combination of all of that. So why would I write their stories in a pretty, elegant way? This is not to say these teens are not intelligent. They are. Some of them read at college level, take A.P. classes, and study hard. They know many big, fancy, SAT words. Those that don’t pursue academics to their full potential are still smart. But what I’ve found is that in the privacy of my office most teens prefer to talk in an informal manner rather than with refined formality. They choose to speak with their broken hearts.

It is with all this in mind that I wrote Rani Patel In Full Effect and the forthcoming Jaya and Rasa: A Love Story. I am excited for the world to meet Jaya and Rasa. They are blends of real patients I’ve had the privilege of treating (I must confess that there are also bits and pieces of me in Jaya!).

The way I write how Jaya experiences things in his life—such as private school, wealth, elitism, modern day Native Hawaiian oppression, lack of acceptance of his gender by his Gujarati Indian parents, bullying by his classmates, depression, self-blame for his parents’ fights, low self-worth, and the unconscious recreation of his parents’ relationships with Rasa—is how many of my patients describe their similar experiences.

The way I write how Rasa maintains a happy front while likening herself to a strong black widow spider is part of her response to trauma. It’s how she’s managed to survive her challenging circumstances. She’s learned to equate her body and sex as power and control over men who are actually abusing her. Under her black widow exterior is a vulnerable girl who hasn’t been given the chance to develop her self-worth or identity apart from being an object for others. She hasn’t had the luxury of a safe life in which her basic needs are met.

Neither Jaya nor Rasa have been taught or encouraged to become self-aware or speak their minds concerning their true thoughts, feelings, and impulses. So they’ve both stayed in their heads trying to survive their respective hardships. Their patterns of negative thoughts, feelings, and behaviors become more and more ingrained as the years pass. That is, until they meet each other. The intense love that develops between them forces them to confront the flaws in their internalized ways of functioning in the world. They realize that they have to keep it real or they might die.

In my work as a child & adolescent psychiatrist, it is not uncommon for families to present with a lack of understanding of the nature of their child or teen's suffering and vulnerability. They love their child or teen and want to help him or her feel better but they might be stuck in patterns of enabling, blame, intolerance, or judgement. And those patterns often get placed on me while I’m leading them in family therapy. I don't expect everyone to like me or like the recommendations I make. But only by pointing out deeply ingrained dysfunctional patterns despite the tension in the room can I hope to foster true healing for the patient and the family. So, I take a deep breath, thicken my skin and keep trying to facilitate open-mindedness to change.

And I've discovered that it is the same way with my adventure in writing YA fiction. Sometimes people are stuck in valuing writing only if it's done in a style they've been conditioned to admire and respect. I don't expect everyone to like what I write. But only by pointing out that there can be deeply ingrained bias in what is expected from authors can I hope to make noteworthy contributions to diversity in the YA fiction world. Only by pointing out my encounters with lack of understanding, intolerance, and judgement of Rani (the sixteen-year-old protagonist in Rani Patel In Full Effect)can I hope to press the importance of differences in voice, perspective, and experience. Rani’s a brown girl growing up on a tiny island in the middle of the Pacific. Her voice is angry and unconfident. Her perspective is narrow based on loss of connection with her mother and her Gujarati culture, but she’s found some protection in her deep connection with hip hop culture. She’s also a survivor of chronic covert and overt incest. I’ve provided psychiatric treatment to teens who think, feel, talk, or act similarly to Rani. To say Rani’s dumb, naive, one dimensional, asking for it, or doesn’t speak intelligently is to minimize the biologic effects of trauma. And that, from my point of view, not only shows a lack of understanding of trauma, but also reveals intolerance, judgment, and lack of empathy. To write her story with big flowery, fancy words and sentences would perhaps be more like the experience of a white girl in suburbia, or a brown girl with the privilege of family stability not afforded to Rani.

As Rani would say, haters gonna hate. And meanwhile, I’ll take a deep breath, thicken my skin, and keep writing.

This past week, numerous teen girl patients, more than the usual number, have informed me that they’ve been triggered into hating how they look and who they are when they compare themselves to their peers who post bikini & thong bikini photos of butts and boobs. Many of these posted photos have been of female bodies without faces.

These types of photos also show up on my social media feed.

When my patients bring up these issues with me, I try to help them find empowerment in themselves as intelligent, creative, thoughtful human beings, and not as simply bodies.

And after a couple of photos I saw today, I couldn’t shut myself up. So...this rhyme is for my daughter, my teen girl patients, for all teen boys and girls, for teens struggling with gender identity issues, and for anyone who has a daughter/sister/mother/spouse/girlfriend.

STOP VISUALLY ASSAULTING ME (& YOURSELF)!

I don’t think it’s feminist

To exist

For the pleasure of misogynists

And the pain of girls who enlist

Bikini clad Instagram photos as self-worth building assists

And I’m pissed

Cuz I partake in social media to express

And seek inspiration to progress

In building intellectual success

But more and more people oppress

With photos of girls’ ass and boobs, no face

And now it seems commonplace

For the female form to be presented as an object that needs to conform

To one deforming norm

Ass and boobs sans face have been transformed

Into a woman’s identity

Instead of what’s above the neck, a free

Thinking person with a brain that can carry on weighty

Discussions and is full of thoughts and feelings that remain

Suppressed because patriarchy deems

Her ideas a needless scheme

Cuz porn & social media have brainwashed guys to the extreme

that girls are supposed to only give ‘em wet dreams and make ‘em cream

And girls when you post your ass & boobs cuz you buy into the pipe dream

Of building self-esteem

By gaining hundreds of likes

You’re reinforcing that there’s only one way to be ladylike

And that’s by using your round parts

To please men

And this is America & you have the right to post body shots again & again

But please listen

More than pissed, I’m worried

Worried for my daughter, my teen patients, and all girls caught in the flurry

There’s nothing anyone can do to ease the indescribable grief of the friends and families of the Pulse hate crime victims. I think most of us want to express feelings of love, sympathy, and attempts at empathy to them. I will try to do this by relentlessly pursuing the completion of my current YA novel, The Calamitous Love of Jaya & Rasa—my small bid at continuing the discussion on the truths about the horrific consequences of lack of gun control and lack of tolerance and acceptance for the LGBTQA+ community.

I bet you know a Patel. Patels are everywhere. Literally. The Patel diaspora from India is such that there are over 500,000 of them living in countries outside of India (1). In the United States alone, there are over 145,066 Patels and according to the 2000 U.S. census, the surname ranks 174th on the list of most common surnames in the country (2). And they’re not all related.

Most Patels are from the Indian state of Gujarat. Their is some debate over the exact origin of the Patel surname, but it’s likely the term Patel first referred to village leaders and/or a caste of landowners or farmers in Gujarat. Nowadays, Patels are involved in many types of professional occupations ranging from doctors to lawyers to engineers, though they are most often associated with small business trades, particularly motels and franchises.

Patels immigrate to America for the many of the same reasons as people from other countries.

For economic opportunities. For educational opportunities for their children. For a better life. My parents were no exception- they immigrated in the early 70’s seeking the American dream.

If you know a Patel, it’s probable that you know someone who is hardworking, independent, bent on accumulating wealth, and driven to help their children find educational success. Whether it’s the Patel motel owner. The Patel husband and wife 7-11 owners whose tireless dedication to the business allows their two children the opportunities to become Dr. Patel and a Patel engineer. Steve Zwick gives an interesting account of Patels on Devon Avenue in Chicago, highlighting their roots in Gujarat and their reasons for immigration to the United States (3). These stories abound, and I’ve been witness to my fair share growing up as a first person on both sides of my family to be born in America. Stories about the financial triumphs of friends of my parents. Stories of amazing academic achievement of the children of immediate and extended family members. Stories of the prosperity of unrelated Patels that spread in family gossip like the colored powder on Holi.

Patels often pay a price when they permanently move away from Gujarat. The price could be working two jobs with no days to rest. The price could be difficulty with adjusting to the American culture and language. It could be discrimination. The list is long, and not unique to Patel immigrants.

But, there is something missing from the Patel immigrant story. Something that casts a long, dark shadow. Something that I fear many Patels, including myself, haven’t been able to name. Something we don’t handle because we are so thankful to live in the land of opportunity. It’s something that crept into the suitcases of our parents as they boarded the Air India flight from Mumbai to London to New York City. Something that was easily caged or hidden in the cultural confines of Gujarat, where the close knit homogenous social network allowed for good of the whole and the good of the individual. But, once out of this cultural safety net, the something started it’s slow sabotage. And some Patels suffered. Like fish out of water.

I’m sure many Patel immigrants escaped unscathed, and achieved the American dream shielding themselves from the explosive mixture of old and new. But this wasn’t the experience for a number of the Patels I’ve known. For although they may have secured some financial stability and perhaps even amassed great wealth, their most intimate relationships broke. Couples. Parents and children. Adult siblings. From the outside, no one could see the damage, because there might not have been divorce or CPS involvement. No actual splitting of families.

But I’ve seen the collateral damage. The problem is that Patels don’t talk about it. Even as they whisper about rumors in the Patel community or chitchat over chai no one speaks of the long term emotional ramifications of malfunctioning interpersonal relationships in families. Maybe in Gujarat, the endless social supports from other Patels provided enough cushion to prevent or diminish these negative emotional outcomes, but in the States, I’m sure it’s a different story. Balancing adjustment to a new culture while trying to hold onto the old culture creates interpersonal relationship strains and situations unheard of in Gujarat. Some Patels weren’t ready. And perhaps tending to the emotional needs of a spouse or child wasn’t as much of a priority as making it in America. It’s the breakdown of the interpersonal relationships in some Patel families that I think has profoundly affected the succeeding generations. Me included. So much so that I chose the medical speciality of psychiatry, with a focus on children and adolescents, despite being told by several Patels that a psychiatrist is “not a real doctor.”

One thing I know for sure from my years of helping children, teens, and adults in individual, couples, and family psychotherapy is that the healing process absolutely requires talking truthfully about the elephant in the room. And that elephant in the room is often some sort of malfunctioning interpersonal relationship issue.

Since my experience as a Patel was that no one speaks about interpersonal relationship issues, I often wonder how emotionally hurt Patels find healing. I don’t think they go to psychiatrists. Plus, there isn’t much out there in fiction or nonfiction about Patel interpersonal relationship issues, particularly in the young adult genre. Either way, I want to shed light on these interpersonal issues that affect Patels just as much as they affect the families from every culture and nation, immigrant or not.

That’s why I chose the name Rani Patel for the main character in the young adult novel, Rani Patel in Full Effect. Rani Patel, her parents, and their experiences are based on a subtle alchemy of Patel individuals and families I’ve known and some of the non-Patel teen and family patients I’ve treated. Rani Desai, Rani Shah, or Rani Amin would not have had the same impact.

You probably know a Patel. It is my hope that Rani Patel in Full Effect challenges you to think beyond the Patel stereotypes and truly see their humanity in their family relationship complexities. There might be more than you could’ve imagined going on behind the closed doors of the Patel that you know.

1.Global Gujaratis: Now in 129 Nations. The Economic Times. July 4, 2015. http://articles.economictimes.indiatimes.com/2015-01-04/news/57663531_1_gujaratis-patels-united-nations

2.Global Gujaratis: Now in 129 Nations. The Economic Times. July 4, 2015. http://articles.economictimes.indiatimes.com/2015-01-04/news/57663531_1_gujaratis-patels-united-nations

3.Zwick, Steve. Who Are All These Patels? Chicago Reader. February 10, 2000. http://www.chicagoreader.com/chicago/who-are-all-those-patels/Content?oid=901436